US20030144681A1 - Tissue cutting instrument - Google Patents
Tissue cutting instrument Download PDFInfo
- Publication number
- US20030144681A1 US20030144681A1 US10/058,122 US5812202A US2003144681A1 US 20030144681 A1 US20030144681 A1 US 20030144681A1 US 5812202 A US5812202 A US 5812202A US 2003144681 A1 US2003144681 A1 US 2003144681A1
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- United States
- Prior art keywords
- cutter
- tissue
- instrument
- inner member
- cutting
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A61B2017/320032—Details of the rotating or oscillating shaft, e.g. using a flexible shaft
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T407/00—Cutters, for shaping
- Y10T407/19—Rotary cutting tool
- Y10T407/1906—Rotary cutting tool including holder [i.e., head] having seat for inserted tool
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T407/00—Cutters, for shaping
- Y10T407/19—Rotary cutting tool
- Y10T407/1946—Face or end mill
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T407/00—Cutters, for shaping
- Y10T407/22—Cutters, for shaping including holder having seat for inserted tool
- Y10T407/2272—Cutters, for shaping including holder having seat for inserted tool with separate means to fasten tool to holder
- Y10T407/2282—Cutters, for shaping including holder having seat for inserted tool with separate means to fasten tool to holder including tool holding clamp and clamp actuator
- Y10T407/2292—Slidable jaw
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T408/00—Cutting by use of rotating axially moving tool
- Y10T408/89—Tool or Tool with support
- Y10T408/901—Having axially extending peripheral cutting spur
Definitions
- This invention relates to tissue cutting instruments and, more particularly, to cutting blades for cutting tissue at a distal end of a tissue cutting instrument.
- a conventional tissue cutting blade typically includes two coaxial tubes or members, where one tube rotates or reciprocates within the other. Each tube has geometry cut therein to form the cutting edges.
- the tubes are matched with minimal clearances to provide a shearing action between them.
- Bone cutters typically use a burr-type inner member, which does not depend on the outer member for shearing. With both of these designs, the cutting action of the blade is reduced close to the rotational axis of the blade. This is due in part to the surface speed of the blade approaching zero close to the blade axis.
- a tissue cutting instrument in one general aspect, includes an outer member, an inner member received within the outer member, and a cutter coupled to the inner and the outer members such that rotation of the inner member about an axis causes off-axis movement of the cutter.
- the outer member includes a terminal end at a distal end.
- the terminal end is spherical.
- the terminal end is flat.
- the terminal end defines an opening therein and the terminal end opening includes a cutting portion.
- the terminal end opening is formed by a cut into the terminal end.
- the terminal end opening is formed by at least two cuts into the terminal end.
- Each of the two cuts is cylindrical and the two cuts are perpendicular to each other.
- each of the two cuts is v-shaped. In another alternative, each of the two cuts is flat.
- the outer member includes a first chamber and a second chamber and the chambers are located in an inner surface of the terminal end of the outer member. Each chamber is arch-shaped.
- the cutter includes a first shaft and a second shaft and each shaft assembles in a respective one of the chambers.
- the inner member includes a plurality of teeth at its distal end.
- the inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member.
- the cutter is a hollow body and the body defines an opening therethrough.
- the body is a sphere.
- the cutter opening includes a cutting portion and an extended portion.
- the cutter opening is formed by a cut through the cutter.
- the cutter opening is formed by at least two cuts through the cutter. Each of the two cuts are circular and the two cuts overlap to form a cutting portion and an extended portion.
- the cutter opening is molded.
- the cutter includes a first shaft and a second shaft, and the shafts are located 180° apart from each other along an outer surface of the cutter.
- the first shaft includes a plurality of teeth extending from an outer circumference of the first shaft.
- the inner member includes a plurality of teeth on its distal end, and the teeth of the first shaft of the cutter engage with the teeth of the inner member to move the cutter.
- the inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member.
- a method of cutting tissue includes positioning an outer member such that the outer member is adjacent tissue, engaging the tissue with a cutter coupled to the outer member, and moving the cutter to end-on cut the tissue.
- the extended portion of the cutter extends distally beyond a terminal end of the outer member.
- Engaging the tissue includes slicing into the tissue with the extended portion of the cutter.
- Moving the cutter includes rotating an inner member to cause off-axis movement of the cutter.
- the inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member.
- moving the cutter includes engaging the cutter and an inner member while rotating the inner member.
- End-on cutting tissue includes abrading tissue.
- end-on cutting tissue comprises slicing, grabbing, and shearing tissue.
- a method of cutting tissue includes applying a direct cutting force to tissue with a cutter, and mechanically rotating a member to cause off-axis movement of the cutter to end-on cut tissue.
- End-on cutting tissue includes abrading tissue.
- end-on cutting tissue includes slicing, grabbing, and shearing tissue.
- a tissue cutting instrument in another general aspect, includes an outer member having a terminal end, an inner member received within the outer member, and a cutter coupled to the inner and the outer members.
- the cutter includes an extended portion extending distal of the terminal end, and the cutter is configured and arranged to perform end-on cutting.
- the tissue cutting instrument of this invention includes a cutter that rotates off-axis as the inner member rotates axially to end-on cut tissue.
- the cutter slices into targeted tissue, grabs the tissue, and then shears the tissue against the outer member.
- Internal suction facilitates the removal of debris to reduce the possibility of clogging.
- the cutter includes a portion that extends distally beyond a terminal end of the outer member to provide for slicing into the tissue, eliminating the need for suction to draw the tissue to the cutting instrument.
- the tissue cutting instrument's versatility is enhanced to include cutting soft, semi-hard, and hard tissue.
- tissue cutting instrument effectively cuts targeted tissue that is presented as a wall perpendicular to the rotation of the inner member such that in use, an operator can hold the tissue cutting instrument with the terminal end of the outer member perpendicular to and directly adjacent to the tissue for end-on cutting.
- FIG. 1A is a side view of an embodiment of a tissue cutting instrument
- FIG. 1B is an exploded perspective view of a distal portion of the tissue cutting instrument of FIG. 1A.
- FIG. 2A is a side view of the distal portion of FIG. 1B;
- FIG. 2B is another side view of the distal portion of FIG. 2A rotated 90° relative to FIG. 2A;
- FIG. 2C is an end view of FIG. 2B taken along line 2 C- 2 C in FIG. 2B;
- FIG. 2D is an end view of FIG. 2B taken along line 2 D- 2 D in FIG. 2B;
- FIG. 2E is a perspective view of the distal portion of FIG. 2B.
- FIG. 3A is a cross-sectional side view of the distal portion of FIG. 2B taken along section 3 A- 3 A of FIG. 2D;
- FIG. 3B is a cross-sectional side view of the distal portion of FIG. 2B taken along section 3 B- 3 B of FIG. 3A.
- FIG. 4A is a side view of the outer member of the tissue cutting instrument of FIG. 1A;
- FIG. 4B is another side view of the outer member of the tissue cutting instrument of FIG. 1A, rotated 90° relative to FIG. 4A;
- FIG. 4C is an end view of the outer member of FIG. 4B taken along line 4 C- 4 C in FIG. 4B;
- FIG. 4D is an end view of the outer member of FIG. 4B taken along line 4 D- 4 D in FIG. 4B.
- FIG. 5A is a perspective view of the outer member of FIG. 4B;
- FIG. 5B is a cross-sectional side view of the outer member of FIG. 4B taken along section 5 B- 5 B in FIG. 4D;
- FIG. 5C is a cross-sectional side view of the outer member of FIG. 4B taken along section 5 C- 5 C of FIG. 5B.
- FIG. 6A is a side view of the inner member of the tissue cutting instrument of FIG. 1B.
- FIG. 6B is an end view of the inner member of FIG. 6A taken along line 6 B- 6 B in FIG. 6A.
- FIG. 7A is an end view of the cutter of the tissue cutting instrument of FIG. 1B taken along line 7 A- 7 A in FIG. 2B;
- FIG. 7B is a side view of the cutter of FIG. 7A taken along line 7 B- 7 B in FIG. 7A;
- FIG. 7C is an end view of the cutter of FIG. 7A taken along line 7 C- 7 C in FIG. 7B;
- FIG. 7D is a perspective view of the cutter of FIG. 7A.
- FIG. 8 illustrates the tissue cutting instrument of FIG. 1A in use.
- FIG. 9A is a side view and FIG. 9B is an end view of an alternative embodiment of the inner member of the tissue cutting instrument.
- FIG. 10A is an end view of an alternative embodiment of the cutter of the tissue cutting instrument
- FIG. 10B is a side view of the cutter of FIG. 10A taken along line 10 B- 10 B in FIG. 10A; and;
- FIG. 10C is an end view of the cutter of FIG. 10A taken along line 10 C- 10 C in FIG. 10B;
- FIG. 10D is a perspective view of the cutter of FIG. 10A.
- a tissue cutting instrument 100 for cutting hard, semi-hard, or soft tissue end-on includes a hub 105 , an inner member 110 , an outer member 120 , and a cutter 130 .
- the inner member 110 is received within the outer member 120 .
- the inner 110 and the outer 120 members are coupled together by the hub 105 (as is known for arthroscopic cutting blades having a stationary outer member and an inner member driven by a rotary driver).
- U.S. Pat. No. 5,871,493 to Sjostrom et al. assigned to Smith & Nephew describes a motorized handpiece that rotates an inner member.
- the hub 105 is molded directly to the inner 110 and outer 120 members or, for example, if the hub is metal, then glued, epoxied, or soldered to the inner and outer members, for instance.
- the cutter 130 is coupled to the inner 110 and the outer 120 members such that rotation of the inner member 110 causes off-axis movement of the cutter 130 , as described farther below.
- rotation of the inner member 110 about axis X, in the direction shown by r causes off-axis movement, e.g., rotation, of the cutter 130 about axis Y, in the direction shown by R.
- the cutter 130 rotates, the cutter 130 is held directly against the targeted tissue such that the cutter 130 slices into the tissue and then shears the tissue between the cutter 130 and the outer member 120 , like the cutting action of a pair of scissors.
- a distal portion of the tissue cutting instrument 100 includes the inner member 110 , the outer member 120 , and the cutter 130 .
- the cutter 130 includes a cutting edge 134 with a portion 134 a that extends distally beyond a terminal end 125 a of the distal portion 125 of the outer member 120 .
- the cutter 130 moves off-axis, as shown by arrow R, to slice into tissue.
- the slice of tissue is then brought into contact with a cutting portion 124 of the outer member 120 where the tissue is sheared off by the motion of the cutting edge 134 of the cutter 130 relative to the cutting portion 124 of the outer member 120 .
- the cut tissue is aspirated away from the surgical site through a hollow interior lumen 112 of the inner member 110 .
- cutter 130 is coupled to the inner member 110 and the outer member 120 , when the tissue cutting instrument 100 is assembled.
- Cutter 130 includes shafts 131 , 132 located 180° apart on its outer surface. Shaft 132 engages a distal engaging portion 115 of the inner member 110 such that as the inner member 110 is rotated by a rotary driver about axis X, in the direction shown by arrow r, the cutter 130 moves off-axis in the direction shown by arrow R, for example, rotates perpendicular to the rotation of the inner member 110 about axis Y, as described further below.
- the outer member 120 is tubular with a hollow interior 122 .
- the outer member 120 includes a distal portion 125 having cutting portion 124 with a terminal end 125 a .
- the distal portion 125 is, for example, spherical or dome-shaped. This shape of the distal portion 125 assists in retaining or coupling the cutter 130 with the inner 110 and the outer 120 members.
- the cutting portion 124 is formed by two cylindrical cuts into the distal portion 125 of the outer member 120 .
- the cuts are oriented perpendicular to each other.
- the edge 124 a of the cutting portion 124 is sharpened to provide a sharpened cutting edge against which the tissue is sheared between the cutter 130 and the outer member 120 .
- the distal portion 125 of the outer member 120 also includes a spherical shaped interior surface 126 , as shown in FIG. 5A.
- the interior surface 126 includes two chambers 127 , 128 for receiving shafts 132 , 131 , respectively.
- the chambers 127 , 128 are formed in the interior surface 126 and are located 180° apart from each other.
- Each chamber 127 , 128 for example, is arch-shaped with a diameter 127 d , 128 d and a depth d. Depth d of the chambers 127 , 128 provides clearance for a running fit for shafts 131 , 132 of the cutter 130 .
- the diameter 127 d of chamber 127 is larger than the diameter 128 d of chamber 128 .
- the shafts 131 , 132 of the cutter 130 assemble in the chambers 128 , 127 , respectively, when the cutting instrument 100 is assembled and as described in more detail below.
- the outer member 120 retains the shaft 132 of the cutter 130 against the distal engaging portion 115 of the inner member 110 for purposes described below.
- the inner member 110 is tubular with a hollow interior lumen 112 .
- the inner member 110 includes the distal engaging portion 115 at its distal end.
- the distal engaging portion 115 includes a plurality of teeth 116 extending from a distal facing circumferential edge 115 a .
- a rotary driver as is known with arthroscopic instruments, rotates inner member 110 about axis X, as shown by arrow r.
- Hollow interior lumen 112 of the inner member 110 provides a channel through which tissue debris is aspirated away from the surgical site.
- the cutter 130 includes the cutting edge 134 and the shafts 131 , 132 .
- the cutting edge 134 of the cutter 130 is formed, for example, by two circular cuts through the cutter 130 .
- the two circular cuts overlap each other to form two extended portions 134 a , 134 b , which are each shaped, for example, like a tooth or hook, in the cutting edge 134 that slices into the targeted tissue to initiate a cut.
- the cutter 130 for example, is a spherical hollow body.
- the inner diameter 125 d of the distal portion 125 of the outer member 120 and the outer diameter 130 d of the cutter 130 are selected to provide a clearance between cutter 130 and outer member 120 for shearing tissue.
- the two shafts 131 , 132 protrude from the cutter 130 and are located 180° apart from each other on a common diameter, e.g., lie on the axis of rotation of the cutter 130 .
- Shaft 131 has a smooth outer circumference 131 a .
- Shaft 132 includes a plurality of teeth 132 a , protruding from the outer circumference of the shaft 132 such that shaft 132 looks like a gear.
- Shafts 131 , 132 assemble in chambers 128 , 127 of the outer member 120 , respectively.
- the diameter 127 d of chamber 127 is larger than the diameter 128 d of chamber 128 .
- the smooth shaft 131 fits in the chamber 128 with diameter 128 d ; the toothed shaft 132 in the chamber 127 with diameter 127 d .
- the smooth shaft 131 of the cutter 130 has clearance 131 b (see FIG. 3B) within chamber 128 such that shaft 131 does not contact the distal engaging portion 115 of the inner member 110 .
- the teeth 132 a of shaft 132 of cutter 130 engage with the teeth 116 of the distal engaging portion 115 of the inner member 110 .
- the engagement of the teeth 132 a of the shaft 132 and the teeth 116 of the distal engaging portion 115 of the inner member 110 translates the rotation of the inner member 110 about axis X (in the direction arrow r) to the off-axis movement of the cutter 130 , for example, about axis Y (in the direction of arrow R).
- the cutter 130 moves off-axis, for example, perpendicular to the rotation of the inner member (as shown by arrow R in FIG. 3A).
- an operator holds the distal end of the tissue cutting instrument 100 directly against targeted tissue, for example, fundal tissue in a myomectomy procedure, perpendicular to the tissue for end-on cutting.
- targeted tissue for example, fundal tissue in a myomectomy procedure
- the cutter 130 moves off-axis, for example, rotates perpendicular to the rotation of the inner member 110 about axis Y (shown by arrow R), perpendicular to axis X.
- Extended portion 134 b of the cutter 130 slices into the targeted tissue, grabbing the tissue.
- the cutting portions 124 , 134 of outer member 120 and cutter 130 shear the tissue and the cut tissue is aspirated away along hollow interior 112 of the inner member 110 . Additionally, where the tissue is particularly hard and the cutter 130 is unable to slice into the targeted tissue, the cutter 130 abrades the targeted tissue as it rotates, and the debris is aspirated away along the hollow interior lumen 112 of the inner member 110 .
- the distal engaging portion 215 of the inner member 210 is smooth.
- the cutter 230 includes two smooth shafts 231 , 232 .
- the two shafts 231 , 232 fit within the chambers 128 , 127 of the outer member 120 . Similar running fits and clearances as described above apply.
- Shafts 232 has a rubber surface 232 a , for example, an O-ring, provided thereon. The O-ring 232 a provides a source of friction against the distal engaging portion 215 of the inner member 210 .
- This frictional force causes the cutter 230 to rotate off-axis to end-on cut tissue, as described above.
- the cutter 230 moves off-axis, for example, rotates perpendicular to the rotation of the inner member 210 , as a result of the friction between the shaft 232 with the rubber surface 232 a moving against the smooth distal engaging portion 215 of the inner member 210 .
- Shaft 231 of the cutter 230 (without a rubber surface) has clearance (like 131 b above) within the chamber 127 of the outer member 120 from the inner member 210 so that cutter 230 moves when smooth distal engaging portion 215 contacts rubber surface 232 a.
- Dimensions of the members vary with the specific application or use of the cutting instrument. Dimensional tolerances, such as, for example, clearance between the inner and outer members, are similar to those as known with conventional arthroscopic cutting blades.
- the instrument includes lubrication for its parts or a coating on the cutter.
- a spacer or a washer is added to the chambers or smooth shaft to reduce friction thus reducing any tendency of the cutter to move on-axis with the inner member.
- the cutter can have a cylindrical shape.
- the distal portion of the outer member can be cylindrical or conical.
- the terminal end of the outer member can be flat or angled.
- the cutting portion can be formed by flat cuts or v-shaped grooves or other combinations of shapes.
- the circular cuts in the cutter are, for example, two overlapping diamond shaped cuts or three diamonds or circles providing two extended portions.
- the cutting portion of the cutter can have a single extended portion on one side and two extended portions on another side or other configurations that vary with the specific application or use.
- the inner member rotates, in one alternative, in either direction or reciprocates back and forth about axis X such as in a soft tissue procedure.
- the cutting instrument can be held at a range of angles in relation to the targeted tissue from just greater than 0° to just less than 180°. Accordingly, other embodiments are within the scope of the following claims.
Abstract
Description
- This invention relates to tissue cutting instruments and, more particularly, to cutting blades for cutting tissue at a distal end of a tissue cutting instrument.
- A conventional tissue cutting blade typically includes two coaxial tubes or members, where one tube rotates or reciprocates within the other. Each tube has geometry cut therein to form the cutting edges. For soft tissue cutting blades, the tubes are matched with minimal clearances to provide a shearing action between them. Bone cutters typically use a burr-type inner member, which does not depend on the outer member for shearing. With both of these designs, the cutting action of the blade is reduced close to the rotational axis of the blade. This is due in part to the surface speed of the blade approaching zero close to the blade axis.
- In one general aspect, a tissue cutting instrument includes an outer member, an inner member received within the outer member, and a cutter coupled to the inner and the outer members such that rotation of the inner member about an axis causes off-axis movement of the cutter.
- Some or all of the following features may be included in this aspect of the tissue cutting instrument. The outer member includes a terminal end at a distal end. The terminal end is spherical. Alternatively, the terminal end is flat. The terminal end defines an opening therein and the terminal end opening includes a cutting portion.
- The terminal end opening is formed by a cut into the terminal end. Alternatively, the terminal end opening is formed by at least two cuts into the terminal end. Each of the two cuts is cylindrical and the two cuts are perpendicular to each other. Alternatively, each of the two cuts is v-shaped. In another alternative, each of the two cuts is flat.
- The outer member includes a first chamber and a second chamber and the chambers are located in an inner surface of the terminal end of the outer member. Each chamber is arch-shaped. The cutter includes a first shaft and a second shaft and each shaft assembles in a respective one of the chambers.
- The inner member includes a plurality of teeth at its distal end. The inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member.
- The cutter is a hollow body and the body defines an opening therethrough. The body is a sphere. The cutter opening includes a cutting portion and an extended portion. The cutter opening is formed by a cut through the cutter. Alternatively, the cutter opening is formed by at least two cuts through the cutter. Each of the two cuts are circular and the two cuts overlap to form a cutting portion and an extended portion. In another alternative, the cutter opening is molded.
- The cutter includes a first shaft and a second shaft, and the shafts are located 180° apart from each other along an outer surface of the cutter. The first shaft includes a plurality of teeth extending from an outer circumference of the first shaft. The inner member includes a plurality of teeth on its distal end, and the teeth of the first shaft of the cutter engage with the teeth of the inner member to move the cutter. The inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member.
- In another general aspect, a method of cutting tissue includes positioning an outer member such that the outer member is adjacent tissue, engaging the tissue with a cutter coupled to the outer member, and moving the cutter to end-on cut the tissue. The extended portion of the cutter extends distally beyond a terminal end of the outer member.
- Some or all of the following features may be included in this method for cutting tissue. Engaging the tissue includes slicing into the tissue with the extended portion of the cutter.
- Moving the cutter includes rotating an inner member to cause off-axis movement of the cutter. The inner member rotates axially and the cutter rotates in a direction perpendicular to the direction of rotation of the inner member. Alternatively, moving the cutter includes engaging the cutter and an inner member while rotating the inner member.
- End-on cutting tissue includes abrading tissue. Alternatively, end-on cutting tissue comprises slicing, grabbing, and shearing tissue.
- In another general aspect, a method of cutting tissue includes applying a direct cutting force to tissue with a cutter, and mechanically rotating a member to cause off-axis movement of the cutter to end-on cut tissue.
- Some or all of the following features may be included in this method of cutting tissue. End-on cutting tissue includes abrading tissue. Alternatively, end-on cutting tissue includes slicing, grabbing, and shearing tissue.
- In another general aspect, a tissue cutting instrument includes an outer member having a terminal end, an inner member received within the outer member, and a cutter coupled to the inner and the outer members. The cutter includes an extended portion extending distal of the terminal end, and the cutter is configured and arranged to perform end-on cutting.
- Conventional cutting instruments do not effectively end-on cut tissue when tissue abuts a distal cutting surface of a blade such as when cutting fundal tissue in an intrauterine myomectomy. A typical blade relies on suction to introduce tissue to the cutting surface. Additionally, such blades may rely on shearing of tissue between an inner and an outer member to cut tissue. By changing the axis of rotation of the blade to be different from the axis of rotation of the inner member, e.g., perpendicular to the axis of rotation of the inner member, a tissue cutting instrument can cut more efficiently at its distal end by grabbing and shearing tissue as well as abrading tissue end-on.
- The tissue cutting instrument of this invention includes a cutter that rotates off-axis as the inner member rotates axially to end-on cut tissue. In particular, as the cutter rotates off-axis, the cutter slices into targeted tissue, grabs the tissue, and then shears the tissue against the outer member. Internal suction facilitates the removal of debris to reduce the possibility of clogging. The cutter includes a portion that extends distally beyond a terminal end of the outer member to provide for slicing into the tissue, eliminating the need for suction to draw the tissue to the cutting instrument. As a result, the tissue cutting instrument's versatility is enhanced to include cutting soft, semi-hard, and hard tissue. Additionally, the tissue cutting instrument effectively cuts targeted tissue that is presented as a wall perpendicular to the rotation of the inner member such that in use, an operator can hold the tissue cutting instrument with the terminal end of the outer member perpendicular to and directly adjacent to the tissue for end-on cutting.
- The details of one or more embodiments are set forth in the accompanying drawings and the description below. Other features and advantages will be apparent from the description and drawings, and from the claims.
- FIG. 1A is a side view of an embodiment of a tissue cutting instrument; and
- FIG. 1B is an exploded perspective view of a distal portion of the tissue cutting instrument of FIG. 1A.
- FIG. 2A is a side view of the distal portion of FIG. 1B;
- FIG. 2B is another side view of the distal portion of FIG. 2A rotated 90° relative to FIG. 2A;
- FIG. 2C is an end view of FIG. 2B taken along
line 2C-2C in FIG. 2B; - FIG. 2D is an end view of FIG. 2B taken along
line 2D-2D in FIG. 2B; and - FIG. 2E is a perspective view of the distal portion of FIG. 2B.
- FIG. 3A is a cross-sectional side view of the distal portion of FIG. 2B taken along
section 3A-3A of FIG. 2D; and - FIG. 3B is a cross-sectional side view of the distal portion of FIG. 2B taken along
section 3B-3B of FIG. 3A. - FIG. 4A is a side view of the outer member of the tissue cutting instrument of FIG. 1A;
- FIG. 4B is another side view of the outer member of the tissue cutting instrument of FIG. 1A, rotated 90° relative to FIG. 4A;
- FIG. 4C is an end view of the outer member of FIG. 4B taken along
line 4C-4C in FIG. 4B; and - FIG. 4D is an end view of the outer member of FIG. 4B taken along
line 4D-4D in FIG. 4B. - FIG. 5A is a perspective view of the outer member of FIG. 4B;
- FIG. 5B is a cross-sectional side view of the outer member of FIG. 4B taken along
section 5B-5B in FIG. 4D; and - FIG. 5C is a cross-sectional side view of the outer member of FIG. 4B taken along
section 5C-5C of FIG. 5B. - FIG. 6A is a side view of the inner member of the tissue cutting instrument of FIG. 1B; and
- FIG. 6B is an end view of the inner member of FIG. 6A taken along
line 6B-6B in FIG. 6A. - FIG. 7A is an end view of the cutter of the tissue cutting instrument of FIG. 1B taken along
line 7A-7A in FIG. 2B; - FIG. 7B is a side view of the cutter of FIG. 7A taken along
line 7B-7B in FIG. 7A; - FIG. 7C is an end view of the cutter of FIG. 7A taken along
line 7C-7C in FIG. 7B; and - FIG. 7D is a perspective view of the cutter of FIG. 7A.
- FIG. 8 illustrates the tissue cutting instrument of FIG. 1A in use.
- FIG. 9A is a side view and FIG. 9B is an end view of an alternative embodiment of the inner member of the tissue cutting instrument.
- FIG. 10A is an end view of an alternative embodiment of the cutter of the tissue cutting instrument;
- FIG. 10B is a side view of the cutter of FIG. 10A taken along
line 10B-10B in FIG. 10A; and; - FIG. 10C is an end view of the cutter of FIG. 10A taken along
line 10C-10C in FIG. 10B; and - FIG. 10D is a perspective view of the cutter of FIG. 10A.
- Like reference symbols in the various drawings indicate like elements.
- Referring to FIGS. 1A and 1B, a
tissue cutting instrument 100 for cutting hard, semi-hard, or soft tissue end-on includes ahub 105, aninner member 110, anouter member 120, and acutter 130. Theinner member 110 is received within theouter member 120. The inner 110 and the outer 120 members are coupled together by the hub 105 (as is known for arthroscopic cutting blades having a stationary outer member and an inner member driven by a rotary driver). For instance, U.S. Pat. No. 5,871,493 to Sjostrom et al. assigned to Smith & Nephew describes a motorized handpiece that rotates an inner member. Thehub 105 is molded directly to the inner 110 and outer 120 members or, for example, if the hub is metal, then glued, epoxied, or soldered to the inner and outer members, for instance. Thecutter 130 is coupled to the inner 110 and the outer 120 members such that rotation of theinner member 110 causes off-axis movement of thecutter 130, as described farther below. - In use, rotation of the
inner member 110 about axis X, in the direction shown by r, causes off-axis movement, e.g., rotation, of thecutter 130 about axis Y, in the direction shown by R. As thecutter 130 rotates, thecutter 130 is held directly against the targeted tissue such that thecutter 130 slices into the tissue and then shears the tissue between thecutter 130 and theouter member 120, like the cutting action of a pair of scissors. - Referring to FIGS.2A-2E, a distal portion of the
tissue cutting instrument 100 includes theinner member 110, theouter member 120, and thecutter 130. Thecutter 130 includes acutting edge 134 with aportion 134 a that extends distally beyond aterminal end 125 a of thedistal portion 125 of theouter member 120. As theinner member 110 rotates, as shown by arrow r, thecutter 130 moves off-axis, as shown by arrow R, to slice into tissue. The slice of tissue is then brought into contact with a cuttingportion 124 of theouter member 120 where the tissue is sheared off by the motion of thecutting edge 134 of thecutter 130 relative to the cuttingportion 124 of theouter member 120. The cut tissue is aspirated away from the surgical site through a hollowinterior lumen 112 of theinner member 110. - Referring to FIGS. 3A and 3B,
cutter 130 is coupled to theinner member 110 and theouter member 120, when thetissue cutting instrument 100 is assembled.Cutter 130 includesshafts Shaft 132 engages a distalengaging portion 115 of theinner member 110 such that as theinner member 110 is rotated by a rotary driver about axis X, in the direction shown by arrow r, thecutter 130 moves off-axis in the direction shown by arrow R, for example, rotates perpendicular to the rotation of theinner member 110 about axis Y, as described further below. - Referring to FIGS.4A-4D, the
outer member 120 is tubular with ahollow interior 122. Theouter member 120 includes adistal portion 125 having cuttingportion 124 with aterminal end 125 a. Thedistal portion 125 is, for example, spherical or dome-shaped. This shape of thedistal portion 125 assists in retaining or coupling thecutter 130 with the inner 110 and the outer 120 members. - The cutting
portion 124, as shown in FIG. 4D, for example, is formed by two cylindrical cuts into thedistal portion 125 of theouter member 120. The cuts are oriented perpendicular to each other. Theedge 124 a of the cuttingportion 124 is sharpened to provide a sharpened cutting edge against which the tissue is sheared between thecutter 130 and theouter member 120. - Referring to FIGS.5A-5C, the
distal portion 125 of theouter member 120 also includes a spherical shapedinterior surface 126, as shown in FIG. 5A. Theinterior surface 126 includes twochambers shafts chambers interior surface 126 and are located 180° apart from each other. Eachchamber diameter chambers shafts cutter 130. Thediameter 127 d ofchamber 127 is larger than thediameter 128 d ofchamber 128. Theshafts cutter 130 assemble in thechambers instrument 100 is assembled and as described in more detail below. - In addition to providing a shearing surface, the
outer member 120 retains theshaft 132 of thecutter 130 against the distal engagingportion 115 of theinner member 110 for purposes described below. - Referring to FIGS. 6A and 6B, the
inner member 110 is tubular with a hollowinterior lumen 112. Theinner member 110 includes the distal engagingportion 115 at its distal end. The distalengaging portion 115 includes a plurality ofteeth 116 extending from a distal facingcircumferential edge 115 a. A rotary driver, as is known with arthroscopic instruments, rotatesinner member 110 about axis X, as shown by arrow r. Hollowinterior lumen 112 of theinner member 110 provides a channel through which tissue debris is aspirated away from the surgical site. - Referring to FIGS.7A-7D, the
cutter 130 includes thecutting edge 134 and theshafts cutting edge 134 of thecutter 130 is formed, for example, by two circular cuts through thecutter 130. The two circular cuts overlap each other to form twoextended portions cutting edge 134 that slices into the targeted tissue to initiate a cut. Thecutter 130, for example, is a spherical hollow body. Referring particularly to FIG. 5C, theinner diameter 125 d of thedistal portion 125 of theouter member 120 and theouter diameter 130 d of thecutter 130 are selected to provide a clearance betweencutter 130 andouter member 120 for shearing tissue. - The two
shafts cutter 130 and are located 180° apart from each other on a common diameter, e.g., lie on the axis of rotation of thecutter 130.Shaft 131 has a smooth outer circumference 131 a.Shaft 132 includes a plurality ofteeth 132 a, protruding from the outer circumference of theshaft 132 such thatshaft 132 looks like a gear. -
Shafts chambers outer member 120, respectively. Thediameter 127 d ofchamber 127 is larger than thediameter 128 d ofchamber 128. Thesmooth shaft 131 fits in thechamber 128 withdiameter 128 d; thetoothed shaft 132 in thechamber 127 withdiameter 127 d. Thesmooth shaft 131 of thecutter 130 hasclearance 131 b (see FIG. 3B) withinchamber 128 such thatshaft 131 does not contact the distal engagingportion 115 of theinner member 110. - The
teeth 132 a ofshaft 132 ofcutter 130 engage with theteeth 116 of the distal engagingportion 115 of theinner member 110. The engagement of theteeth 132 a of theshaft 132 and theteeth 116 of the distal engagingportion 115 of theinner member 110 translates the rotation of theinner member 110 about axis X (in the direction arrow r) to the off-axis movement of thecutter 130, for example, about axis Y (in the direction of arrow R). As theinner member 110 rotates (as shown by arrow r in FIG. 3A), thecutter 130 moves off-axis, for example, perpendicular to the rotation of the inner member (as shown by arrow R in FIG. 3A). - Referring to FIG. 8, in use, an operator holds the distal end of the
tissue cutting instrument 100 directly against targeted tissue, for example, fundal tissue in a myomectomy procedure, perpendicular to the tissue for end-on cutting. As theinner member 110 is rotated about axis X (shown by arrow r), thecutter 130 moves off-axis, for example, rotates perpendicular to the rotation of theinner member 110 about axis Y (shown by arrow R), perpendicular to axis X.Extended portion 134 b of thecutter 130 slices into the targeted tissue, grabbing the tissue. The cuttingportions outer member 120 andcutter 130, respectively, shear the tissue and the cut tissue is aspirated away alonghollow interior 112 of theinner member 110. Additionally, where the tissue is particularly hard and thecutter 130 is unable to slice into the targeted tissue, thecutter 130 abrades the targeted tissue as it rotates, and the debris is aspirated away along the hollowinterior lumen 112 of theinner member 110. - Other embodiments are within the scope of the following claims. For example, referring to FIGS. 9A and 9B, the distal engaging
portion 215 of theinner member 210 is smooth. Referring to FIGS. 10A-10D, thecutter 230 includes twosmooth shafts shafts chambers outer member 120. Similar running fits and clearances as described above apply.Shafts 232 has arubber surface 232 a, for example, an O-ring, provided thereon. The O-ring 232 a provides a source of friction against the distal engagingportion 215 of theinner member 210. This frictional force causes thecutter 230 to rotate off-axis to end-on cut tissue, as described above. As theinner member 210 is rotated, thecutter 230 moves off-axis, for example, rotates perpendicular to the rotation of theinner member 210, as a result of the friction between theshaft 232 with therubber surface 232 a moving against the smooth distalengaging portion 215 of theinner member 210. -
Shaft 231 of the cutter 230 (without a rubber surface) has clearance (like 131 b above) within thechamber 127 of theouter member 120 from theinner member 210 so thatcutter 230 moves when smooth distalengaging portion 215contacts rubber surface 232 a. - Dimensions of the members vary with the specific application or use of the cutting instrument. Dimensional tolerances, such as, for example, clearance between the inner and outer members, are similar to those as known with conventional arthroscopic cutting blades.
- A number of embodiments have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope. For example, the instrument includes lubrication for its parts or a coating on the cutter. Alternatively, a spacer or a washer is added to the chambers or smooth shaft to reduce friction thus reducing any tendency of the cutter to move on-axis with the inner member. The cutter can have a cylindrical shape. The distal portion of the outer member can be cylindrical or conical. The terminal end of the outer member can be flat or angled. As an alternative, the cutting portion can be formed by flat cuts or v-shaped grooves or other combinations of shapes. The circular cuts in the cutter, in another alternative, are, for example, two overlapping diamond shaped cuts or three diamonds or circles providing two extended portions. Alternatively, the cutting portion of the cutter can have a single extended portion on one side and two extended portions on another side or other configurations that vary with the specific application or use. The inner member rotates, in one alternative, in either direction or reciprocates back and forth about axis X such as in a soft tissue procedure. Alternatively, in use, the cutting instrument can be held at a range of angles in relation to the targeted tissue from just greater than 0° to just less than 180°. Accordingly, other embodiments are within the scope of the following claims.
Claims (37)
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DE102008034927B4 (en) * | 2008-07-26 | 2016-01-14 | Hans Aidelsburger | Device for removing tissue and knives for such a device |
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US9814484B2 (en) | 2012-11-29 | 2017-11-14 | Microfabrica Inc. | Micro debrider devices and methods of tissue removal |
US9907564B2 (en) | 2008-06-23 | 2018-03-06 | Microfabrica Inc. | Miniature shredding tool for use in medical applications and methods for making |
US20180078274A1 (en) * | 2008-06-23 | 2018-03-22 | Microfabrica Inc. | Miniature Shredding Tools for Use in Medical Applications, Methods for Making, and Procedures for Using |
US10064644B2 (en) | 2008-06-23 | 2018-09-04 | Microfabrica Inc. | Selective tissue removal tool for use in medical applications and methods for making and using |
US10492822B2 (en) | 2009-08-18 | 2019-12-03 | Microfabrica Inc. | Concentric cutting devices for use in minimally invasive medical procedures |
US10676836B2 (en) | 2003-06-27 | 2020-06-09 | Microfabrica Inc. | Electrochemical fabrication methods incorporating dielectric materials and/or using dielectric substrates |
US20220031347A1 (en) * | 2018-09-18 | 2022-02-03 | Brigham Young University | Developable and collapsable internal cutting mechanism |
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US10939934B2 (en) * | 2008-06-23 | 2021-03-09 | Microfabrica Inc. | Miniature shredding tools for use in medical applications, methods for making, and procedures for using |
DE102008034927B4 (en) * | 2008-07-26 | 2016-01-14 | Hans Aidelsburger | Device for removing tissue and knives for such a device |
US10492822B2 (en) | 2009-08-18 | 2019-12-03 | Microfabrica Inc. | Concentric cutting devices for use in minimally invasive medical procedures |
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US20220031347A1 (en) * | 2018-09-18 | 2022-02-03 | Brigham Young University | Developable and collapsable internal cutting mechanism |
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